POP + Urinary Incontinence

Question 1

what can lead to prolapse? (3)

Answer 1

pregnancy/labor/delivery
increased intra-abdominal pressure
atrophy

Question 2

what are the 3 associated cystocele symptoms of prolapse?

Answer 2

heaviness
sensation of bulge
pelvic fullness

Question 3

what worsens cystocele symptoms?

Answer 3

prolonged standing

Question 4

what makes cystocele symptoms better?

Answer 4

lying down

Question 5

usually presents as asymptomatic but can present with low back/sacral pain, perineal pressure, palpable bulge, and rapid progression

Answer 5

enterocele

Question 6

presents with perineal pressure, obstructive defection that requires digital reduction, loose genitals, and palpable bulge

Answer 6

rectocele

Question 7

which type of prolapse is considered anterior?

Answer 7

cystocele

Question 8

which 2 types of prolapse is considered apical?

Answer 8

uterine
vaginal vault

Question 9

which 2 types of prolapse are considered posterior?

Answer 9

rectocele
enterocele

Question 10

procidentia

Answer 10

complete uterine prolapse

Question 11

what are the 2 systems used to quantify amount of prolapse?

Answer 11

baden-walker system
Pelvic Organ Prolapse - Quantification

Question 12

stage is based on position of _____ ___ relative to _____

Answer 12

vaginal walls
hymen

Question 13

what are 5 treatment options for prolapse?

Answer 13

observation
estrogen
kegels/pelvic floor exercises
pessaries
surgery

Question 14

the cardinal ligaments that blend with the utero-sacral ligaments; they attach the upper vagina, cervix, and lower uterine segment to the sacrum and lateral pelvic side walls

Answer 14

level 1

Question 15

the paravaginal attachments found at the level of the ischial spines; function to keep the vagina in the middle, directly over the rectum

Answer 15

level 2

Question 16

provided by the perineal body and membrane, superficial and deep perineal muscles, and endopelvic fascia; support and maintain the normal position of the distal 1/3 of the vagina and introitus (opening)

Answer 16

level 3

Question 17

what is the gold standard treatment for level 1 of the vaginal apex?

Answer 17

sacrocolpopexy

uses surgical mesh to lift organs back into place

Question 18

treatment for level 2 anterior compartment?

Answer 18

anterior colporrhaphy

strengthens vaginal wall muscles and tissues

Question 19

what is the treatment for level 3 posterior compartment?

Answer 19

posterior colporrhaphy

vaginal wall repair

Question 20

AKA vaginal closure; only used in women who no longer desire sexual activity

Answer 20

colpocleisis

Question 21

patient prefers non-surgical treatment, and US shows endometrial stripe of 2mm. Bleeding is most likely from cervix rubbing on underwear. treatment?

Answer 21

estrogen cream
fit patient for pessary

Question 22

urinary incontinence due to urethral hypermobility and/or intrinsic sphincter deficiency

Answer 22

stress incontinence

Question 23

urinary incontinence due to detrusor spasms

Answer 23

urge incontinence

Question 24

some element of urinary retention and urine simply drips out when the bladder is over full

Answer 24

overflow incontinence

Question 25

what part of the evaluation is the most important when evaluating a patient for incontinence?

Answer 25

history

Question 26

45 yo patient G3P3 presents with urinary leakage and has noticed this since the birth of her last child 5 years ago. She has PMHx of asthma, PSxHx of cholecystectomy and tubal ligation. She has mixed incontinence by history and her urinalysis is negative. You see leakage when she coughs and she voids 300cc with a post-void residual of 15cc. what is her likely dx?

Answer 26

overactive bladder

Question 27

what are 4 conservative treatment options for overactive bladder?

Answer 27

bladder retraining
behavior modification
fluid management
pelvic floor exercises

Question 28

what are 2 pharmacological treatment options for overactive bladder?

Answer 28

anti-muscarinic
B3 agonists (Mirabegron)

Question 29

what are 3 procedure treatment options for overactive bladder?

Answer 29

percutaneous tibial nerve stimulation
interstim neuromodulator
botox

Question 30

what are 3 conservative treatment options for stress UI?

Answer 30

biofeedback
pelvic floor exercises
pessary

Question 31

what are 2 pharmacological treatment options for stress UI?

Answer 31

vaginal estrogen
tricyclic antidepressants (imipramine)

Question 32

what are 3 procedure treatment options for stress UI?

Answer 32

urethral bulking to tighten urethra
burch urethropexy (suspension)
midurethral slings